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10 Cards in this Set

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5yr old white female complains of fever, marked weakness, pallor, bone pain and bleeding from nose; HPI: increasing fatigability and recurrent infections in last few months; PE: epistaxis, ecchymotic patches on skin, sternal tenderness, slight hepatosplenomegaly with nontender lymphadenopathy; LABS: normocytic normochromic aanemia, absolute lymphocytosis with excess blasts (30+%), neutropenia, thrombocytopenia, CD10 positive, TdT positive, EBV negative.
Acute Lymphocytic Leukemia (ALL)
25yr old white woman presents with high-grade fever, menorrhagia, and weakness; HPI: recurrent infections in recent weeks; PE: pallor, multiple purpuric patches over skin; hepatospenomegaly, gingival hyperplasia, sternal tenderness; LABS: normocytic, normochromic anemia, thrombocytopenia, leukocytosis of myeloblasts and promyelocytes, neutropenia, prolonged PT and PTT; GROSS: bone erosion due to marrow expansion, chloroma formation, splenomegaly; MICRO: myelophthisic bone marrow, Auer rods in myelocytes, peroxidase positive stains on bone marrow and gingivial biopsy
Acute Myelogenous Leukemia (AML)
12yr old male presents with high fever, marked pallor and epistaxis, history of recurrent URIs and high grade fever treated with parenteral antibiotics; HPI: marked weakness over past 3 months, lives near industrial unit that handles benzene; PE: pallor of skin and conjunctiva, oral and nasal mucosal petechiae, purpuric patches visible on skin, no significant lymphadenopathy, no hepatosplenomegaly; LABS: anemia, neutropenia, and thrombocytopenia (pancytopenia), anemia with low retic count, normal RBC morphology, negative Coombs' test; GROSS: increased yellow marrow, decreased red marrow; MICRO: hypocellular bone marrow with empty spaces populated by fat cells, fibrous stroma and scattered lymphocytes.
Aplastic Anemia
66yr old white male recently diagnosed with chronic lymphocytic leukemia comes into ER complaining of fatigue and tachycardia; HPI: urine has been progressively turning dark and red over the course of the day; PE: dyspnea, pallor of skin and mucous membranes, slight jaundice, splenomegaly; LABS: severe anemia, positive Coombs' test, reticulocytosis, spherocytosis, "bite cells", hemoglobinuria, increased serum indirect bilirubin; GROSS: congestive splenomegaly due to extravascular hemolysis.
Autoimmune Hemolytic Anemia
35yr old woman admitted to hospital with left-sided weakness upon awakening; HPI: her first 3 pregnancies were spontaneously aborted and the 4th resulted in unexpected fetal death; PE: mild pallor, left hemiplegia w/ exaggerated deep tendon reflexes, positive Babinski's sign, reddish-blue mottling of skin in fishnet pattern; LABS: mild thrombocytopenia, prolonged PTT, false positive VDRL, presence of anticardiolipin antibody (ACA); IMAGING: hypodensity in right internal capsule.
Antiphospholipid Antibody Syndrome
9yr old girl of African descent presents with swelling of left side of face and jaw of 3wks duration; HPI: loosening of upper second left molar 2 wks ago, no pain despite size of tumor; PE: pallor, large, firm, ill-defined mass encompassing entire upper mandible with mild ipsilateral exophthalmos with deformation on left side of face; LABS: normocytic, normochromic anemia, mild leukopenia, positive direct Coombs' test, chromosomal translocation t(8;14) involving c-myc gene; IMAGING: no mediastinal widening; MICRO: cells of uniform size with non-granular basophilic nuclei and some vacuoles, 2-5 nucleoli, high mitotic index and "starry sky" image pattern.
Burkitt's Lymphoma
65yr old male lost 12 lbs over the past 4 months with episodes of epistaxis and extreme fatigue; PE: generalized nontender lymphadenopathy, pallor, enlargement of spleen and liver; LABS: markedly elevated WBC (124,000), 90% lymphocytes, no lymphoblasts, mild thrombocytopenia, Coombs-positive hemolytic anemia, smudge cells; GROSS: lymph node enlargement, hepatosplenomegaly with tumor nodule formation; MICRO: bone marrow biopsy shows extensive infiltration, mainly by normal-looking lymphocytes, few lymphoblasts with small dark, round nuclei and scant cytoplasm, B lymphocytes don't mature properly.
Chronic Lymphocytic Leukemia (CLL)
40yr old white male has occasional fatigue and increasing abdominal girth (large spleen); PE: pallor of skin and mucous membranes, pain on palpation over sternum; LABS: markedly elevated WBC count (130,000), immature granulocytes with normal-appearing ones, basophilia, eosinophilia, early thrombocytosis, late thrombocytopenia, low leukocyte alkaline phosphatase, chromosomal translocation t(9;22) bcr-abl gene (Ph).

55yr old male presents with swelling, pain, redness of right leg; HPI: he's retired and leads sedentary lifestyle, admits to 70-pack-year smoking history and occasional alcohol intake; PE: fever, tachycardia (106), mild HTN (142/92), normal RR, lower extremity swollen, pain from calf palpation and dorsiflexion of right foot (Homan's sign); LABS: blood D-dimer elevated; IMAGING: thrombi occluding right common femoral and popliteal veins
Deep Vein Thrombosis
25yr old white female continues to bleed steadily after a normal, spontaneous vaginal delivery; HPI: after manual exploration of uterus and subsequent procedure, patient begins to bleed profusely from her gums and continues bleeding vaginally; PE: diffuse bleeding in gums and oral mucosa, bleeding diathesis of skin (petichiae and purpura) with oozing from venipuncture sites; LABS: low fibrinogen, low platelets, prolonged PT and activated PTT, elevated fibrin split products, especially D-dimers; MICRO: microthrombi in arterioles and capillaries, leading to microinfarcts in practically any organ, also hemorrhages and petechiae in involved organs
Disseminated Intravascular Coagulation